46D0524904 CLIA NUMBER - INTERMOUNTAIN BEAR RIVER CLINIC

Laboratory Demographics

  • CLIA Code: 46D0524904
  • Facility Name: INTERMOUNTAIN BEAR RIVER CLINIC
  • Facility Address: 935 NORTH 1000 WEST
    TREMONTON, UT
    ZIP 84337
  • Facility Phone: 435 207-4800
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JONATHAN M. GARDNER
  • NPI Number: 1679582944
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 46D0524904
LAB Type Physician Office
Facility Name INTERMOUNTAIN BEAR RIVER CLINIC
Street 935 NORTH 1000 WEST
City TREMONTON
State UT
ZIP 84337
Phone 435 207-4800
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/4/2025
Certificate Expiration Date 6/3/2027
Facility Type Physician Office
Lab Director JONATHAN M. GARDNER

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This page was last updated on: 9/29/2025